National Speakers' Bureau - Speaker Request Form

Thank you for your interest in Doctors Without Borders' Speakers' Bureau. We are delighted at the increased interest in our relief efforts, and we regret that our pool of volunteer doctors, nurses, and administrators is not large enough to fulfill all speaker requests, so we ask you to read through the guidelines below before requesting a speaker.

We request a minimum of 50 people in attendance for events. Speaker requests will be considered on an individual basis, with special consideration for events focusing on public health, health and human rights, and international health.

Our volunteers are involved in various projects around the world on an ongoing basis and are often out of the country on short notice. It can therefore be difficult for them to commit far in advance to an event at a particular time and place here in Canada. Therefore, in most circumstances, we will not be able to confirm speakers until eight or six weeks before the event you are planning.Requests should ideally be made 8 to 10 weeks in advance of the event, but at the very least with 5 weeks notice.

The Speakers' Bureau will contact you within 10 working days of your request. This contact will seek clarifications, if required, and confirm whether or not your request has been judged appropriate. If so, efforts will be made to identify a speaker, though finding one is not guaranteed.

Should the proposed date for the event specified below change - or should you decide to cancel the event, you are kindly asked to inform us by email.

Organization or Group Name:

Contact Person:

Address:

City:

Province/Territory:

Postal Code:

Home Telephone:

Work Telephone:

Fax Number:

E-mail Address:

Date of Event:

Month

Day

Year

Is this date flexible? If so, please specify a range during which the event could take place and how much advance notice you need to set the exact date:

Is there a definite date at which you need to know the name of the speaker, failing which the request should be considered cancelled?

No

Yes

If yes, please specify the date:

Month

Day

Year

Time of Event:

Hour

:

Minute

am

pm

Event Location:

Is there a particular speaker you would like to invite to your event? If so, please provide that speaker's name:

If we are unable to find a speaker who lives in your area, is there a budget to cover transportation costs?

Is a stipend/donation being offered? (Please note that our speakers are not entitled to accept a stipend, except to cover reasonable costs involved with participating in the event. However, we welcome donations to MSF.)

Will a meal be provided to the speaker?

Expected Audience Size:

Type of Audience:

What language should the conference be given in?

English

French

English or French

List other scheduled speakers:

Desired Length of Presentation:

Suggested Topic:

Equipment Available for Speakers' Use - Speaking aids that you have available for use during the presentation: